Psycho-trauma and Recovery Across
Scotland’s Secure Estate
Dr Ian Barron
Reader in Trauma Studies, University of Dundee
&
Ms Jen Copley
Forensic Psychologist
Take Home Message
 Trauma is pervasive in our
caseloads and institutions we work
with (children and adults); however
lack of ‘trauma’ lens
 Phase approach and progressive
counting - possible approach for
trauma processing
2 Part Presentation
 Phase 1 – extent and nature of
trauma in secure care & TRT
evaluation
 Phase 2 - TPB across the secure
estate - therapist experience &
experiential activity
Project aims
(Phase 1 and 2)
 Shift focus - behaviour management to addressing
underlying trauma (drives behaviour & results in YP
unresponsive to behaviour programmes)
 Introduce trauma-specific screening & evaluation
(i) Developmental trauma framework to case files
analysis
(i) Trauma history interview
(iii) Trauma-specific measures (PROPS &
CROPS)
 Training in trauma specific programmes & traumasensitive milieu
Phase 1 Pilot Project
 N=17; 14-18yrs; 11 female/6 male; Scottish
Caucasian;
 Relative & absolute poverty; poor quality
housing/homeless (n=2); parental prostitution
(n=5); drug dealing (n=3); substance misusing
(n=11); schedule 1 offenders access to home (n=3),
mother sectioned under the mental health act
(n=1)
 In free fall , e.g. 40 absconding, 20 break ins, 7
assaults, 3 suicide attempts ….. short period of
time.
Case file analysis
 Trauma invisible in medical files
 Physical rather than mental health focus
 No connection - embodied symptoms & YP trauma
 ‘Scatter Gun’ of professional involvement
 Up to 31 different types of professional per YP –
frequent changes
 Omission of survivor organizations
Extensive abuse histories not set
within trauma lens
 10 types categorized
 sexual abuse (n=12); physical abuse (n=15);
physical assault (n=17); experiencing domestic
violence (n=12); witnessing domestic violence
(n=8); neglect (n=10); emotional abuse (n=7);
hospitalisations (n=9); sudden traumatic losses
(n=17); and frequent placement change (n=17).
 Few coherent chronologies (n=4) - despite
repeated child death recommendations
Lack of Social Justice for YP
vs. multiple legal proceedings
 Despite extensive abuse only 1 YP experienced
justice through Scottish Legal system for harms
done to them
Vs.
 YP experienced multiple police stations, over-night
custody, charges, child protection case
conferences, children’s panels, review meetings,
supervision meetings, care plan meetings …
PTSD unrecognised & triggers
not connected to historical abuse
 Descriptive behaviours - hostility, self-harm, drug
taking etc.
 Omission YP internal intrusive/sensory
experiences
 Few PTSD assessments & no diagnosis as YP
“unpredictable” - invalidating?
 8 files recognised daily events as behavioural
triggers – e.g. derogatory comments to YP
Developmental T symptoms apparent
but not seen as consequences of T
 Extensive behavioural difficulties, charges
 Severely disrupted educational histories
 Violent family & peer relationships
 Little to no hope for future
 Emotional dys-regulated
 Disturbed cognitions (rarely reported)
 Re-victimisation statements (frequent)
 Dissociation (n=2) - no evidence professionals making
connection between substance misuse/self-harm
 Depression rarely named (n=3) – yet symptoms reported.
Conclusion: file analysis
 PTSD & developmental trauma symptoms
pervasive with YP in secure care – no assessment
 Professional reports indicate lack of understanding
of the impact of trauma on YPs presenting
behavioural difficulties
 No trauma-specific programmes
 Health/welfare services need to understand:
(i) the nature of children’s T experience
(ii) how to respond appropriately
What did the young people say –
Trauma history interviews
events and SUDs 0-10
 9 T events on average; multiple 10s - cumulative Ts
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not processing
Multiple T losses: deaths, self/sibling into care, parent
in prison
Violence endemic: gang, assaults experienced and done
Agency traumas: returned to abusive home; hearings;
in custody; into care (esp. 1st time); secure accommodation
No harm conducting trauma histories – psychoeducation
Compared with
standardised measures
Clinical levels (mostly clusters) of:
 PTSD/Complicated Grief (65%)
 Depression (65%)
 Dissociation (18%) yet signs found in nearly
all young people (files)
 Underestimated trauma as measures
developed around ‘single’ events
Manualised Programme
intervention
 Group-CBT ‘Teaching Recovery
Techniques’ (TRT)
 Coping Skills Intrusion/Arousal/Avoidance
 Children and War Foundation Patrick Smith, Bill Yule & Atle
Dyregrov
Evaluation (RCT) of TRT
YP (N=17)
Presenters PSDO team (n=3)
Trauma history interview
SUDs; standardized measures (CRIES-13; MFQ;
ADES; TGIC; SDQ)
 2 weeks pre/post TRT
 Programme fidelity – video analysis
 Interviews YP; Staff focus group
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TRT Findings
Large effect size - reducing SUDs
Small effect size - behavioural change
No statistical difference - standardised measures
YP mostly positive & identified specific helpful strategies
Presenters (i) YP selection and grouping important (ii) liaison
with care/education staff to transfer YP strategies (iii) further
gains after evaluation
 Programme fidelity high
 Substantial financial post-placement gains achieved for some
YP.
 Whole staff group - substantial knowledge gains in T-sensitive
environments
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Phase 2 – Why TPB?
• Privacy - Some harm inappropriate to disclosure in group
• Individual therapy - standard of care for T (NICE)
• Short duration placement impeding group delivery
• Intensive – sessions lasts as long as YP can
• On site therapy - immediate access to treatment
• Phase model enables high levels of engagement/lasting
change
• Manualised/replicable & develop with in-care populations
• Cost saving - time limited behavioural stabilization to
intensive trauma focused treatment
Practitioner perspective
 Limitations of other treatment
approaches
 Targets all behaviours of concern
 Client led, but with clear structure
 Use of imagery
 Provides privacy for client
Programme overview
Standard
Working
alliance
Information
TPB
Getting to know you
Fairy Tale
Once upon a time…
History/Worst list
The knight and the kingdom
Goals
/Motivation
Formulation
Stabilisation
Skill
development
Address
trauma
Generalisation
Relapse
Prevention
Future movies
Identify the Princess
Treatment Contracting
Safety and Stabilisation
Skill Building/Strength
building
Trauma Resolution
The Plan
Fence around
Personal training
Consolidation of gains
Relapse Prevention and
harm reduction
Marry the princess
Training future dragon-slayers
Plant trees
Slay the dragons
Progressive Counting
 Asks the client to go over the trauma in their mind,
starting at a point before the trauma and ending
when the ‘worst bit’ is all over
 You determine the start and end pointsTime/Place/Action; but not required to discuss the
trauma in any detail
 Therapists counts, first from 1-10, then increasing by
10 each time …
 This continues until SUDS down to 0
Structured approach
 All sessions scripted
 Start and end each session in same way
 During ‘getting to know you’ and ‘history’ section, no
follow up questions
 Lots of the exercises use imagery and ask the client
to image situations-this encourages the client to
imagine the actions they will take and not just the
final goal
 After treatment planning select sessions based on
individual needs
Future Movies
 In pairs work through the future movie session
 Practice using the script
 Practice the imagery exercise
 With the final scene - need time, place and action
Webpages and reference lists
 Children and War Foundation -
www.childrenandwar.org
 Ricky Greenwald (Child Trauma Institute) www.childtrauma.com
 Bessell van der Kolk –
www.traumacenter.org/about/about_bessel.php
 Francine Shapiro (EMDR) –
www.emdr.com/francine-shapiro-phd.html
Thank You
Ian Barron
i.g.z.barron@dundee.ac.uk
Jen Copley
jen.copley@kibble.org